Even As Mortality Fell In Most US Counties, Female Mortality Nonetheless Rose In 42.8 Percent Of Counties From 1992 To 2006

Abstract

Researchers increasingly track variations in health outcomes across counties in the United States, but current ranking methods do not reflect changes in health outcomes over time. We examined trends in male and female mortality rates from 1992-96 to 2002-06 in 3,140 US counties. We found that female mortality rates increased in 42.8 percent of counties, while male mortality rates increased in only 3.4 percent. Several factors, including higher education levels, not being in the South or West, and low smoking rates, were associated with lower mortality rates. Medical care variables, such as proportions of primary care providers, were not associated with lower rates. These findings suggest that improving health outcomes across the United States will require increased public and private investment in the social and environmental determinants of health-beyond an exclusive focus on access to care or individual health behavior. I ncreasing attention is being paid to the variation in health outcomes across the United States, most recently with the Robert Wood Johnson Foundation/ University of Wisconsin Population Health Institute's County Health Rankings project.1 Begun in 2010, the initiative measures the overall health of each county in the United States, including mortality rates and several morbidity measures such as rates of low birthweight and number of physically and mentally unhealthy days per month. Such ranking methods reveal a county's current health status, but they do not reflect change-for better or worseduring recent time periods.Rarely does an entire state demonstrate an absolute increase, or worsening, in mortality rates. Rather, some states' mortality rates simply decline, or improve, less rapidly than others' rates do. Measuring mortality at the county level reveals more granular changes in outcomes throughout a state's diverse populations.In In previous research, we examined health outcomes among low-and high-income US counties during 2002-06 and highlighted factors associated with their corresponding mortality rates. 5The present study extends this research to examine trends in age-adjusted mortality rates in US counties between 1992 and 2006 and to identify factors associated with improvement-that is, declines-in county mortality rates. This research is of particular importance because of the slow rates of reductions in geographic, racial, and socioeconomic health disparities, despite repeated calls for action. Study Data And MethodsData Our sample consisted of 3,140 counties or county equivalents-for example, administrative divisions of a state such as parishes or boroughs-in the United States. We compiled county-level data from four sources, including the County Health Rankings, 1 the Behavioral Risk Factor Surveillance Survey (1994-2000 survey panels), the Centers for Disease Control and Prevention's compressed mortality database, 6,7 and the 2000 US census.We examined the county-level percentage change in all-cause, age-adjusted mortality rate per 100,000 residents age seventy-five...

Health Disparities Among African Americans

“…According to Kindig and Cheng (2013) the Hispanics who immigrated to the United States may be the healthiest and they tend to live in extended families which are very supportive and have community relationships which also build strong social support that may lead to better health outcomes. Nonetheless, low income and low education levels of minority groups are less likely to receive preventive services such as cancer screenings, and to seek medical treatment for chronic conditions such as high blood pressure, diabetes and other chronic diseases.…”

“…For example, a study of mortality rates conducted by Kindig and Cheng (2013) found that factors most strongly associated with higher mortality rates are those experienced by individuals who live below the poverty line and also those with no college education. They found that the rates of obesity are higher among people living below the poverty line.…”

The Economic Promise of Delayed Aging

“…With people staying healthy until a much later age, it might be more feasible to justify raising the eligibility age for public programs for seniors. Arguments against doing so often note that life expectancy increases in lower socioeconomic groups have lagged far behind those in better-off groups (Ketcham and Simon 2008;Kindig and Cheng 2013). A future in which delayed aging increased the health of all socioeconomic groups would make these increases in eligibility ages more palatable.…”

Premature Mortality in North Carolina

“…Another limitation is that we have not examined differences between men and women. Kindig and Cheng recently reported that female mortality rose in 42.8% of US counties between 1992 and 2006 [30]; analysis of trends in premature mortality by sex is needed. We are also unable to report time series trends due to space limitations.…”